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Addressing Critical Fungal Pathogens Under a One Health Perspective: Key Insights from the Portuguese Association of Medical Mycology

Summary

Four dangerous fungal species pose growing threats to human health worldwide, especially for people with weakened immune systems. Portugal’s medical experts have reviewed the current situation, finding these fungi increasingly resistant to treatment, present in hospitals and the environment, and occasionally spreading from animals to people. The review emphasizes the need for better testing, coordinated tracking systems, and approaches that consider human, animal, and environmental health together to combat this emerging crisis.

Background

Fungal infections represent a significant global public health challenge, with critical pathogens including Aspergillus fumigatus, Candida auris, Candida albicans, and Cryptococcus neoformans causing severe mycoses with rising antifungal resistance. The World Health Organization designated these four species as critical priorities due to their high mortality rates, particularly in immunocompromised individuals, and their growing resistance to antifungal drugs.

Objective

The Portuguese Association of Medical Mycology (ASPOMM) conducted a comprehensive national study to address WHO recommendations regarding critical fungal pathogens. The study aimed to highlight unmet needs in local knowledge about fungal infections, their epidemiological distribution, antifungal resistance patterns, and to promote integrated One Health approaches linking human, animal, and environmental health.

Results

The study documented significant prevalence of Aspergillus fumigatus (19.7% of invasive fungal infections), Candida albicans (40-74% of candidemia cases with 2.19 per 100,000 incidence), and Cryptococcus neoformans (0.042 per 100,000 incidence with 46.5% mortality). Azole resistance in A. fumigatus varied from 3.0-33.3% depending on species and source, while C. albicans showed variable azole resistance (0.8-27%) across studies. C. auris was rare but emerging, with the first Portuguese case reported in 2023.

Conclusion

The paper emphasizes the urgent need for coordinated national surveillance systems for fungal infections and antifungal resistance in Portugal. It advocates for integrative One Health approaches that coordinate human clinical, veterinary, and environmental monitoring to effectively manage critical fungal pathogens and address diagnostic, therapeutic, and resistance challenges.
  • Published in:Mycopathologia,
  • Study Type:Review, Position Paper, Epidemiological Summary,
  • Source: PMID: 40818022, DOI: 10.1007/s11046-025-00981-3
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